Odontogenic Infections

Dr.Mohamed Rahil (( Maxillofacial surgeon ))

Tikrit dentistry college 2015 – 2016

• Inoculation : entry of pathogenic microbes into the body without disease occurring.

• Infection : entery and proliferation of pathogenic microbes in to the body resulting in triggering of the defense mechanism, a process manifesting as inflammation.

• Inflammation is the localized reaction of vascular and connective tissue of the body to an irritant, resulting in the development of an exudate rich in proteins and cells , Inflammation may be caused by,microbes, physical and chemical factors,(heat, irradiation).

• Acute Inflammation. This is characterized by rapid progression and is associated with typical signs and symptoms. If it does not regress completely, it may become subacute or chronic.

• Subacute Inflammation. This is considered a transition phase between acute and chronic inflammation.

• Chronic Inflammation. This procedure presents a prolonged time frame with slight clinical symptoms and is characterized mainly by the development of connective tissue.

Body response to infection

• Hyperemia

• Precipitation of fibrin network to wall off the infected region

• Phagocytosis of bacteria and dead cells

• Disposal of necrotic debris by macrophage

clinical signs and symptoms of infection

• redness • hottness • swelling • pain • loss of function

Odontogenic infections

• Periapical infections

Periodontal infections

Pericoronal infections

Pericoronal infections

Etiology : • Food impaction • Trauma from opposing tooth • Virulent micro-organism • Lowering of the host resistance

• Acute pericoronitis

• Sub Acute pericoronitis

• Chronic pericoronitis

Treatment

• Drainage of pus if present • If no pus ,gentle irrigation of the

pericoronal space with normal saline

• Extraction of opposing upper tooth or selective grinding

• Antibiotic • Extraction of impacted tooth

Bacteriology

• Mostly mixed infections (aerobic and anaerobic)

Spread of odontogenic infections

• Cellulitis :spread of infection into the loss ct

• Suppurative infections : charectarized by abscess formation

Suppurative infection

Cellulitis

Routes of infection spreading

• Direct continuity

• Lymphatic

• Blood stream

Factors that influence the spread of odontogenic infections

• Virulence of micro-organism • Patient immune system • Anatomical factors that influence the

direction of infection spread : • A. site of source of infection • B.point at which pus escape

• Natural barriers (fascia ,muscle,bone)

Physical examination

Infection of facial spaces

Submandibular space infections

Submental space infections

Sublingual space infections

Ludwigs angina

Ludwigs angina

• Causes

• Dental infections(90%) • Sunmandibular gland infections • Mandibular fractures • Soft tissue laceratios and wounds in the floor

Signs and symptoms

Treatment

• Securing airway • GA should be avoided • Surgical drainage • AB

Submassetric space infections

Pterygomandibular Abscess

Lateral Pharyngeal Abscess

Retropharyngeal space infection

Peritonsillar (Quinsy) abscess

Infection of spaces related to upper jaw

Upper lip infections

Canine fossa infections

Buccal space infection

Infra temporal space Abscess

Subperiosteal in the palate

Maxillary antrum

Cavernous sinus thrombosis

Clinical features

• Marked edema and congestion of the eyelids and conjunctiva

• Proptosis and ptosis • Ophthalmoplegia and dilated

pupil • Papilloedema • Fever • Deprressed level of

consciousness

Treatment

• AB • Heparin • Treatment of odontogenic causes

Principles of treatment of odontogenic infections

• Dental treatment • Surgical treatment

Methods of drainage

• Through the root canal • Through the socket by extraction • Through fenestraion of the alveolar bone • Through incision

Indications for incision and drainage

• Signs of pus accumulation • When the involved compartment are

inaccessible • Serious and rapidly evolving infections of

neck and floor of the mouth

Principle of incision and drainage 1. Should put on healthy skin and mucosa as possible , in area of maximum fluctuancy

2. Esthetically accepted area

3. should include only skin and subcutaneous tissues and dissection through deeper tissue should be done bluntly

4.Drain should be used after after evacuation of the pus 5. Wound margins should be cleaned daily to remove clots and debris 6. Sample of pus should be obtained and sent to the laboratory for culture and sensetivity test

Prior to surgical drainage, a sterile aspirate is obtained for culture and sensitivity

Palatal abscess , incision parallel to the greater palatine vessels

An incision at submandibular region should be placed two fingers’ breadth below the lower border to avoid injury of the marginal mandibular branch of the facial

nerve

- to allow the discharge of tissue fluids and pus from the wound by keeping it patent - allows for debridement of the abscess cavity by irrigation

Penrose corrugated

Medical treatment

• Hydration • Soft diet • Analgesics • Maintain good oral hygiene • AB

Indications for the use of AB in odontogenic infection

• Acute cellutitis • Acute pericoronitis with fever and trismus • Deep fascial space infections • Compromised patients

Guid lines for use appropriate antibiotics

• Determine the causative organisms • Determine the antibiotic sensetivity • Use of least toxic AB • Should know the patient drug history • bacteriocidal better than bacteriostatic • Cost effective • Proper dose and adequate length

Indications for combination of AB therapy

1.when we need to increase the antibiotic spectrum 2. when we need to increase the bacteriocidal effect 3.to prevent rapid development of bacterial resistance 4.In sever rapidly progressive infections

Monitoring of the patient to check:

• Response to the treatment • Recurrence of infection • Presence of allergic reaction • Toxicity reaction • Secondary infections

Causes of failure of AB therapy

• In adequate surgical treatment • Depressed host defence • Presence of foreign body • Problems with use Ab

Sinus formation

Nectrotizing fascitis

Thank you for listening